Decline in heart disease deaths: progress and puzzle.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to M Feinleib.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
There seems to be much epidemiologic evidence implicating a variety of modifiable risk factors in the occurrence of coronary artery disease. Although "common sense" would imply modification of each of these risk factors, on both an individual and a national basis, in order to prevent the occurrence of coronary artery disease in middle and later life, the direct evidence for a beneficial effect from such modifications is, at present, quite meager. Nevertheless, there seems to be a growing awareness and also a growing change in lifestyle and health behaviors that will tend to accomplish the "common sense" recommendations. It is important that monitoring systems be put in place to document the extent of these lifestyle changes and to evaluate their effect on the continuing trends in coronary artery disease incidence and mortality. Joint efforts in the United States, Israel, and other countries will go far to quantitate these effects in these naturally occurring experiments.
Cigarette smoking is a potential confounder of the relationship between obesity and mortality, and statistical control for this factor requires careful consideration. Framingham Heart Study subjects were weighed, their stature measured, and cigarette smoking histories obtained at the first biennial examination starting in 1949. Of men under desirable weight (Metropolitan relative weight [MRW], less than 100%), more than 80% were smokers, while only about 55% of the extremely overweight men were cigarette smokers. When age-, smoking-, and MRW-specific mortalities for 26 years of follow-up were calculated in these men, it was found that smokers had higher mortality than nonsmokers but that in the smokers and nonsmokers, minimum mortalities occurred for subjects who were initially in the "desirable weight" group (MRW, 100% to 109%). Among cigarette smokers, lean men (MRW, less than 100%) experienced considerably elevated mortality, often higher than that in all but the most overweight cigarette smokers. These findings suggest that elevated mortality in low-weight American men results from the mortality risks associated with cigarette smoking and demonstrates the need for controlling for cigarette smoking when considering the relationship between relative weight and mortality. Furthermore, the concept of "desirable weight" developed by the Metropolitan Life Insurance Co in 1959 and subsequently distributed in tabular form is validated by this long-term study. Thus, even those men who were near the average weight (about 20% above "desirable weight") showed appreciably elevated mortality. This finding is contrary to the widely held view that moderate overweight carries no increased risk.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.